<div class="am-u-sm-12 widget main-w" style="width: 100%;">
	<div class="am-u-sm-12">
		<div class="am-u-sm-12 cl-p">
			<fieldset class="cl-p cl-m">
				<legend style="margin: 0;"><span class="am-icon-arrow-circle-o-left" style="margin-right: 30px;font-weight: 900;"></span>单位资质认证</legend>
			</fieldset>
		</div>
	</div>
	<div class="am-u-sm-12">
		<form class="am-form-inline tpl-form-border-form" enctype="multipart/form-data" data-ajax="1" data-check="1" action="qualifications" method="post">
		<div class="am-u-sm-12 border-bottom" style="margin-bottom: 10px;padding:0 0 10px 0 ;">
			单位信息：<span class="approve-state">未认证</span>
		</div>
		<div class="am-u-sm-12 cl-p">
			<div class="am-u-sm-12 cl-p unit_name" style="margin-bottom: 10px;">单位名称：<span  class="company_name">公司名称</span></div>
			<div class='file-w'>
				<div class="am-u-sm-12 cl-p" style="margin-bottom: 10px;position: relative;">
					营业执照：
					<span style="padding: 0px;color: #4777ff;border-style: solid">
						<!--<div class="am-btn am-btn-primary am-radius am-btn-sm">-->
							点击选择图片
						<input type="file" data-dwd='1' data-type='img' style="position: absolute;left: 80px;top: 0;width: 50px;opacity: 0;" name="image"/>
						<!--</div>-->
					</span>
				</div>
				<div class="am-u-sm-12" style="margin-bottom: 10px;">
					<div style="width: 200px;height: 150px;margin-left: 70px;">
					<img class="fileimg" data-magnify="1" src="{$static_dir}/assets/img/wait_img.jpg" style="width: 100%;height: 100%;" />
					</div>
				</div>
			</div>
			<div class="am-u-sm-12 cl-p" style="margin-bottom: 10px;">公司邮箱：<span class="unit_mailbox"></span></div>
			<div class="am-u-sm-8 cl-p">
				<div style="width：100%;padding-left: 70px;box-sizing: border-box;">
					<div class="am-u-sm-6">
						<div class="am-u-sm-12 cl-p"  style="margin-bottom: 10px;">
							<div class="am-u-sm-12 cl-p">
								<input type="text" class="am-form-field" placeholder="公司邮箱" name="mail"/>
							</div>
						</div>
					</div>
				</div>
			</div>
			<div class="am-u-sm-12 cl-p" style="margin-bottom: 10px;">开票资料：</div>
			<div class="am-u-sm-8 cl-p">
				<div style="width：100%;padding-left: 70px;box-sizing: border-box;">
					<div class="am-u-sm-6">
						<div class="am-u-sm-12 cl-p"  style="margin-bottom: 10px;">
							<div class="am-u-sm-12 cl-p">
							发票抬头
							</div>
							<div class="am-u-sm-12 cl-p">
							<input type="text" class="am-form-field" placeholder="与单位或公司资质上的名字一致" name="fapiaotaitou"/>
							</div>
						</div>
						<div class="am-u-sm-12 cl-p" style="margin-bottom: 10px;">
							<div class="am-u-sm-12 cl-p">
							公司注册地址
							</div>
							<div class="am-u-sm-12 cl-p">
							<input type="text" class="am-form-field" placeholder="与单位或公司资质上的名字一致" name="gongsizhuchedizhi"/>
							</div>
						</div>
						<div class="am-u-sm-12 cl-p"  style="margin-bottom: 10px;">
							<div class="am-u-sm-12 cl-p">
							开户行名称
							</div>
							<div class="am-u-sm-12 cl-p">
							<input type="text" class="am-form-field" placeholder="需精确到支行" name="kaihuhangmingcheng"/>
							</div>
						</div>
					</div>
					<div class="am-u-sm-6">
						<div class="am-u-sm-12 cl-p"  style="margin-bottom: 10px;">
							<div class="am-u-sm-12 cl-p">
							纳税人识别号
							</div>
							<div class="am-u-sm-12 cl-p">
							<input type="text" class="am-form-field" placeholder="输入纳税人识别号，15-20位" name="nashuirenshibiehao"/>
							</div>
						</div>
						<div class="am-u-sm-12 cl-p" style="margin-bottom: 10px;">
							<div class="am-u-sm-12 cl-p">
							公司注册电话
							</div>
							<div class="am-u-sm-12 cl-p">
							<input type="text" class="am-form-field" placeholder="手机号或固定电话" name="gongsizhuchedianhua"/>
							</div>
						</div>
						<div class="am-u-sm-12 cl-p" style="margin-bottom: 10px;">
							<div class="am-u-sm-12 cl-p">
							开户行账号
							</div>
							<div class="am-u-sm-12 cl-p">
							<input type="text" class="am-form-field" placeholder="输入纳税人识别号，15-20位" name="kaihuhangzhanghao"/>
							</div>
						</div>
					</div>
				</div>
			</div>
			<div class="am-u-sm-4"></div>
			<div class="am-u-sm-12">
				<div style="width：100%;padding-left: 70px;box-sizing: border-box;">
					<input type="submit" value="提交" class="am-btn am-btn-primary am-radius am-btn-sm">
					<!--<button type="button" class="am-btn am-btn-primary am-radius am-btn-sm keep">提交申请</button>-->
					<button type="button" class="am-btn am-btn-default am-radius am-btn-sm back">取消</button>
				</div>
			</div>
		</div>
		</form>
	</div>
</div>